Inquiry, Affidavit Target Podiatrist

Investigators Seek Evidence Of Fraud

June 28, 1996|By JEANNE PECK Daily Press

NEWPORT NEWS — Investigators have raided the Newport News and Hayes offices of podiatrist Harry A. Hieke Jr., searching for evidence that he defrauded insurers hundreds of times during a 40-month period ending Sept. 30.

According to the affidavit, Hieke overbilled the federal and private insurers for some procedures, billed for procedures he did not perform, and performed procedures that patients did not need.

The raid was organized after a Medicare investigator audited Hieke's files for a portion of the 40-month period from Oct. 1, 1993, to Sept. 30, 1995.

``The mini-audit was performed on patient files chosen due to Dr. Hieke's requests for reconsideration on previously denied Medicare claims,'' the affidavit said. ``The mini-audit indicated that Dr. Hieke billed non-covered routine nail care as surgical procedures. The entries in the medical records did not give specific procedure descriptions, but used terminology such as `debrided to tolerance' (a debridement is toenail trimming).''

The purpose of the raid was to gather evidence to determine if any charges - specifically Medicaid fraud or grand larceny, both felonies - should be brought against Hieke, the affidavit said. Clerks at courts in Newport News and Gloucester County said charges had not been filed against Hieke as of Thursday afternoon.

Hieke's offices remain open. He did not return calls placed to his offices Wednesday and Thursday.

The affidavit also said that a Medicaid file review performed in February 1995 showed that Hieke's Medicaid billings were higher than average in a dozen categories. Trigon's analysis of 1,509 Hieke claims processed between Sept. 29, 1992, and May 9, 1995, showed that the podiatrist charged for the highest and most expensive service in 753 of the cases, the affidavit said. Hieke received $75,515.42 from Trigon during the period.

``This billing pattern is consistent with upcoding to a higher level of service than actually provided which would result in a higher reimbursement to the provider,'' the affidavit said.

In addition, the affidavit said, a Trigon investigator found ``that in the Tidewater region, approximately 99 percent of other podiatrists were able to treat Trigon insured at a lower cost/patient than Dr. Hieke.''

Hieke has been a Medicaid and Trigon doctor since 1980 and a Medicare provider since 1981. Funded by the federal government, Medicare provides reimbursement for medical care to the aged and certain disabled persons under age 65. Medicaid provides help to the poor.

No one from the state attorney general's office could be reached for comment.

ALLEGATIONS FROM THE AFFIDAVIT

After interviewing former Family Foot Specialists employees, federal and state investigators reported in an affidavit that:

* Podiatrist Marc Fink, who worked with Harry A. Hieke Jr. from October 1994 to February 1995, told investigators that "Dr. Hieke did not try conservative treatment on patients before scheduling surgery, and that the employees of FFS received monetary bonuses for selling surgeries. Dr. Fink thought that Dr. Hieke's decisions to do surgery on some of the patients (were) not based on medical necessity, but financial gain."

* An insurance billing clerk at Hieke's Newport News office instructed a file clerk to bill routine foot care, such as toenail clippings, as ingrown toenails, a treatment covered by most insurance companies. The file clerk said the billing clerk "stressed the importance of upcoding routine foot care" so the office could receive reimbursement. The woman also said she was reprimanded for not billing "various non-covered procedures" as covered procedures.

The affidavit also had information about nine patients treated by Hieke. Each claimed Hieke either billed them for treatments he did not provide or performed unnecessary treatments or surgeries. According to the affidavit:

* A Medicaid recipient said Hieke removed all of her toenails on her right foot because she had a black fungus under her toenails. The patient asked for medication as an alternative to the $989 surgery, but said Hieke insisted on surgery.

* Hieke earned $395 from Medicaid for removing two toenails from a patient when he removed only one. The patient originally sought treatment for a hammer toe, but was told she had fungus under a toenail, and that the toenail would have to be removed.